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Clinical 2.0 winter > Colorectal Cancer > Flashcards

Colorectal Cancer Flashcards

1
Q

risk factors for developing colorectal cancer

A 
increases with age 
more common in industrialized world - western diet?
diet high in fats, red meats
inadequate intake of fiber fruits and vegetables
family history 
alcohol intake
smoking 
obesity 
inflammatory bowel disease
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2
Q

rectal cancer is defined as

A

arising below peritoneal refection of <12cm from the anal verge

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3
Q

colon cancer is more common than

A

rectal cancer

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4
Q

most common colorectal cancer

A

sigmoid colon/rectum

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5
Q

pathophys

A

colorectal adenocarcinomas remain superficial for a long time and slowly invade the deeper layers of the intestinal wall
extension through the bowel wall into the pericolonic fat
more distant spread can take place to the liver and lungs

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6
Q

signs and symptoms

A 
changes in bowel habits
diarrhea or constipation 
blood in stool 
narrow stools
ab and gas pain 
weight loss
tenesmus(inclination to evacuate the bowels)
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7
Q

why should people get screened

A

survival rate much better in the beginning
very bad by stage 4
decreases the risk of dying

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8
Q

screening tests

A 
stool blood guaiac test to detect blood in stools
sigmoidoscopy
barium enema 
colonoscopy 
carcinoembryonic antigen
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9
Q

screening is effective because

A

we can detect precancerous early stage cancers in people who dont show symptoms
can confirm and more easily treat cancer in early stages

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10
Q

who should be tested and how often

A

> 50 evaluated annually with fecal occult blood testing unless high risk

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11
Q

primary curative procedure for stages 1-3

A

surgery

resection of the bowel

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12
Q

why do we do radiation to tumor bed and surgically inaccessible areas of tissue

A

to decrease local recurence

can be used for lessening symptoms

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13
Q

stage 1

A

local diseas eno invasion of muscular mucosa

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14
Q

stage 2

A

invasion of muscular mucosa

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15
Q

stage 3

A

lymph node involvment

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16
Q

stage 4

A

metastatic disease

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17
Q

application of chemo in colorectal cancer

A

adjuvant after surgery in stage 2 and 3

primary therapy of metastatic colon and rectal cancers

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18
Q

most commonly used agent in colorectal cancer

A

fluorouracil

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19
Q

fluorouracil toxicity based on type of admin

A

bolus - grade 3 and 4 hematological toxicity

continuous infusion - hand foot syndrome

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20
Q

what is hand foot syndrome

A

paiful reddening of skin
should report any changes to palms and soles asap
prevent by moisturizing and avoiding heat and friction

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21
Q

treatment of hand foot syndrome

A

topical anesthetics
cold
oral analgesic

22
Q

FU use

A

adjuvant and metastatic

23
Q

irinotecan mechanism and use

A

top 1 inhibitor
metastatic or FU resistance
first line for metastatic colorectal in combo with FU and leucovorin

24
Q

irinotecan problem

A

diarrhea early and late onset

25
Q

oxaliplatin class and use

A

third gen platinum analog

adjuvant and metastatic

26
Q

oxaliplatin SE

A

peripheral neuropathy
laryngeal spasm
cold intolerance

27
Q

raltitrexed class and use

A

thymidilate synthetase inhibitor

metatstatic

28
Q

capecitabine use and class

A

fluoropyrimdine - can be delivered at hom e

adjuvant and metastatic

29
Q

capecitabine metabolized to

A

fluorouracil

investigated in combos as an alternative to infusional FU

30
Q

dosing of capecitabine

A

twice daily oral for 14 days then 7 day rest period

31
Q

capecitabine AE

A

palmar plantar erythrodysesthesiia (hand foot)
diarrhea
stomatitis

32
Q

bevacizumab class and use

A

monoclonal antibody directed against vascular endothelial growth factor
metastatic not adjuvant

33
Q

use of vascular endothelial growth factor

A

promotes growth of vascular endothelial cells derived from arteries and veins

promotes endothelial cell survival

34
Q

bevacizumab toxicity

A

perforation
hypertension
bleeding
thromboembolism

35
Q

mechanism of cetuximab

A

chimeric monoclonal antibody directed at cancer cells overexpressing the epidermal growth factor receptor frequently seen in colorectal cancers

36
Q

cetuximab AE

A

weakness, malaise, fever, headache, acneiform rash

37
Q

what is panitumumab and its use

A

fully human EGFR antibody

survival benefit late line therapy***

38
Q

disease free survival as a primary end point

A

allows to make a quicker decision of efficacy so drug development time can be shortened and better therapy available to patients quicker

39
Q

is adjuvant therapy for stage 2 required

A

still unknown

40
Q

stage 2 colon cancer who should be treat (adjuvantly??)

A 
no molecular low risk factors
<60yoa
less than 9 nodes removed
T4 tumors
perforation
41
Q

stage 3 colon cancer standard adjuvant

A

6 months of oxaliplatin based therapy

42
Q

stage 2 colon cancer treatment

A

6 months capecitabine

43
Q

adjuvant in rectal

A

during radiation fluorouracil 200mg/m2/day
preoperative fluorouracil with radiation
4 months of post op oxaliplatin based therapy

44
Q

FU mechanism

A

pyrimidine antagonist

45
Q

how leucovorin increased survival with FU

A

enhances binding of FdUMP to target enzyme

46
Q

route to improve survival and decrease toxicity with FU

A

continuous infusion

47
Q

irinotecan vs oxaliplatin

A

same efficacy choice depends on toxicity

irinotecan: no neuropathy, dose reduction for hepatic dysfunction
oxaliplatin: less alopecia, mucositis, and nausea, safer in hepatic dysfunction

48
Q

risk factor for oxaplatin persistent neurotoxicity

A

total cumulative dose

all patients will experience sensory neuropathy after 4 cycles

49
Q

acute oxaliplatin neurotoxicity

A

in 2-48 hrs

rapid and complete recovery

50
Q

persistent oxaliplatin neurotoxicity

A

affects fingertips and toes then hands and feet
persists between cycles
increases in duration and intensity
slow recovery

Clinical 2.0 winter (28 decks)

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